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1.
Background
Prostate cancer (PCa) originating from the prostate base may intrude into the urinary bladder and may be misdiagnosed as bladder cancer. In this retrospective study, we reviewed the clinic data on PCa cases which were initially misdiagnosed as bladder cancer in order to identify diagnostic methods that would allow a better differential diagnosis for PCa.Methods
Out of a total of 455 patients treated for PCa at our hospital between April 2003 and June 2011, 14 patients (3.1%) had been initially misdiagnosed as urinary bladder urothelial cell carcinoma. The clinical data on these 14 cases was retrieved and analyzed.Results
Of the 14 patients, 11 patients were eventually diagnosed with PCa after MRI examination, and seven out of these had PCa with bladder neck invasion. Prostate needle biopsy or transurethral resection of prostate (TURP) revealed that all 14 patients had adenocarcinoma of prostate with Gleason scores ranging from 7 to 9. Nine patients received TURP for hematuria or lower urinary tract blockage. The mean follow-up was 37 months, during which six patients survived.Conclusions
As clinical presentation and in emergency settings, prostate cancer originating from the prostate base can be confused with bladder cancer originating from the neck or the triangle region of the urinary bladder. Serum prostate specific antigen (PSA) levels and digital rectal examination, in combination with transrectal ultrasound (TRUS), MRI, and prostate needle biopsy are valuable tools for definitive differential diagnosis of the basal prostate cancer. 相似文献2.
P. C. Johnston H. C. Courtney S. J. Hunter D. R. Mc Cance 《Irish journal of medical science》2012,181(2):277-279
Background
Pituitary tumours that present with nasal symptoms are uncommon. Management can be difficult due to their aggressive nature, location and extension.Methods
We report a series of three cases of prolactinomas that enlarged inferiorly presenting initially as nasal polyps.Results
Recurrence of symptoms (case 1) prompted testing for serum prolactin and examination of histology confirmed the presence of a prolactinoma. In cases 2 and 3, radiological evidence of a pituitary mass prompted testing for a prolactinoma. No patients exhibited clinical signs of hyperprolactinaemia. All three cases have residual tumour at 2–4 years after diagnosis, despite prolactin levels approaching the normal range on dopaminergic therapy.Conclusion
Pituitary tumours that invade the nasal cavity are rare and clinicians should be aware of their existence. A prolactinoma should be considered in the differential diagnosis of nasopharyngeal tumours. Measurement of serum prolactin can expedite a diagnosis and prevent delay of treatment with dopamine agonists. 相似文献3.
Introduction
It is becoming increasingly common to request computed tomography (CT) to rule out space occupying lesions before lumbar puncture (LP), even in patients with no clinical signs. Imaging trends within a busy district general hospital in Oxfordshire, UK were analysed with results used to clarify when imaging should be considered mandatory.Method
A retrospective six month sample was obtained comprising all adults considered for LP. Observed frequencies of abnormal examination findings compared with abnormal investigations were used to determine sensitivity, specificity, positive predictive, and negative predictive values to assess the validity of using a normal clinical examination as a basis for excluding CT.Results
64 patients were considered for LP. In total, 58 patients underwent LP, with a single patient receiving two. After an abnormal CT scan, six patients did not undergo a planned LP. In all six of these cases subarachnoid haemorrhage was detected, and in all cases this was considered a probable diagnosis. In no case was an LP precluded by an unsuspected space occupying lesion. Neurological examination showed a sensitivity of 0.72 (0.52 to 0.93), specificity 0.78 (0.64 to 0.91), positive predictive value 0.61 (0.41 to 0.83), and negative predictive value 0.85 (0.73 to 0.97).Discussion
The high sensitivity and negative predictive values support normal neurological examination as an effective predictor of normal CT scan. This permits the recommendation in cases where subarachnoid haemorrhage is not suspected, a CT scan can be avoided provided there are no abnormal findings on physical or fundoscopic examination. 相似文献4.
Background
Bilateral simultaneous rupture of the quadriceps tendon is a rare entity. They are often associated with degenerative changes of the tendons and predisposing conditions such as diabetes or excessive steroid use. They most commonly tend to occur in patients of 40 years of age or older.Materials and methods
We describe a case of a 67-year-old man with simultaneous rupture of both quadriceps tendons.Conclusion
The diagnosis can be difficult and often delayed or missed in the initial examination. We report bilateral quadriceps tendon rupture in a previously healthy patient with good post-operative functional outcome. 相似文献5.
O'Connor C 《Irish journal of medical science》2011,180(2):327-332
Background
Dementia patients in Ireland live 8 years on average after diagnosis and health policy aims to ensure patients are cared for in the home for as long as possible. 相似文献6.
Background
The majority of strokes are due to ischaemia. Risk factors include atrial fibrillation, hypertension and smoking. The incidence can be reduced by addressing these risk factors. This study examines the prevalence of risk factors and their treatment in a cohort of patients with ischaemic stroke registered on a Dublin stroke database. 相似文献7.
Baoxin Wang Junjie Yuan Xinwei Chen Hongming Xu Yuan Zhou Pin Dong 《Saudi medical journal》2015,36(11):1363-1366
Objectives:
To retrospectively describe our 10-year experience with extracranial non-vestibular head and neck schwannomas by presenting their clinical features, diagnostic methods, surgical decisions, and treatment outcomes.Methods:
This is a retrospective study conducted at the Department of Otolaryngology, Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Shanghai First People’s Hospital, Shanghai, China. The medical records of 46 patients diagnosed with schwannoma in the extracranial head and neck region as confirmed on paraffin-embedded sections from January 2003 to December 2012 were reviewed.Results:
All tumors were benign, and 52% presented as asymptomatic palpable solitary masses. Compressive symptoms, which can represent meaningful indicators of the nerve of origin were commonly noted. The most common nerve of origin was the brachial plexus (n=13, 28.3%).Conclusion:
While postoperative histopathologic examination is still the gold standard, fine needle aspiration cytology, CT scan, and magnetic resonance imaging may be useful in the diagnosis of schwannomas. As schwannomas are radioresistant, and as, despite their benign nature, can cause severe secondary symptoms, the best treatment of choice is complete excision with preservation of functions.Neurogenic tumors of the head and neck are relatively rare, and provide an interesting topic in terms of the clinical manifestation, diagnosis, and treatment. It comprise a series of neoplasms, including schwannomas, neurofibromas, and neuroepitheliomas, among others. Schwannomas are solitary, encapsulated, slow-growing, benign tumors arising from the Schwann cells of the peripheral, cranial, and autonomic nerves. Almost 25-45% of schwannomas are located in the head and neck region.1 The clinical signs and symptoms vary according to the size and location of the tumor, and the nerve of origin. However, these clinical features are basically meaningless to the definite diagnosis.2 Currently, although preoperative CT and magnetic resonance imaging (MRI) may provide information regarding the diagnosis of schwannoma, it can only be confirmed by postoperative histopathologic examination.2 The preferred curative method is complete surgical resection,2 although it is generally difficult to preserve the function of the affected nerve, owing to the nerve fascicles expanding thinly and randomly on the tumor’s surface. Here, we describe 46 patients with extracranial head and neck schwannomas treated at our hospital during a 10-year period, to provide important information pertaining to the presentation, diagnosis, and management of this tumor. 相似文献8.
Background
Percutaneous techniques are routinely used in the diagnosis and treatment of cardiovascular disease. The transfemoral route is the most frequently used arterial access site for performing these procedures 相似文献9.
Background
Traumatic brain injury is one of the leading causes of death and disability among young people. However outcomes from traumatic brain injury can be improved by use of parameters such as intracranial pressure monitoring (ICP) to guide treatment, early surgical intervention and management of these patients in a neurosurgical centre. 相似文献10.
Poots J Kennedy R Dennison T Gatt M Blair PH McKinley A Harkin DW 《Irish journal of medical science》2011,180(2):363-367
Introduction
Peripheral arterial disease causing intermittent claudication (IC) causes decreased quality of life and significant morbidity. We hypothesized that triage of patients referred with suspected IC at a nurse-led rapid access vascular examination (RAVE) clinic would identify those patients requiring vascular surgery assessment. 相似文献11.
Davood Jafari Hooman Shariatzade Farid Najd Mazhar Behzad Abbasgholizadeh Ahmad Dashtebozorgh 《Medical journal of the Islamic Republic of Iran》2013,27(2):62-66
Background
The hand and wrist bones are infrequent sites for osteoid osteoma, and its diagnosis can be difficult. This paper reports 25 cases of osteoid osteoma in the hand and wrist.Methods
Records of the 25 patients who had pathological conditions of osteoid osteoma of the hand and wrist were reviewed and analyzed.Results
Twenty-five cases of osteoid osteoma of the hand and wrist were treated in 20 years period. The average age was 25.2±7.6 years (range, 16 to 46 years) with men to women and right to left side ratio of 5.25 and 4 respectively. The most common site was in the proximal phalanx (ten cases). The diagnosis was made using x-rays, three- phase Technetium bone scans, CT, and MRI and all the diagnoses were confirmed by histological examination. The average time from the onset of symptom to successful treatment was 16.3±11.1 months, and at a mean follow-up of 36.6±46.9 mouths. Five recurrences of disease took place in which three of them were operated elsewhere. All five patients subsequently were treated and cured by reoperation.Conclusion
Osteoid osteoma is relatively rare lesions in the hand and wrist that can be a persistent source of hand and wrist pain. Patients under age of 40 who have otherwise unexplained pain should be evaluated. 相似文献12.
Introduction
Carcinoid heart disease is a rare condition in adults. Its diagnosis can be easily missed in a patient presenting to a primary care setting. We revised the advantages of using coronary multidetector computed tomography (MDCT) and cardiac magnetic resonance imaging (MRI) in diagnosing this condition. 相似文献13.
Background:
About 50% of the cerebral ischemia events are induced by intracranial and extracranial atherosclerosis. This study aimed to evaluate the feasibility and accuracy for displaying atherosclerotic plaques in carotid arteries and analyzing their ingredients by using high-resolution new magnetic resonance imaging (MRI) techniques.Methods:
Totally, 49 patients suspected of extracranial carotid artery stenosis were subjected to cranial MRI scan and magnetic resonance angiography (MRA) examination on carotid arteries, and high-resolution bright-blood and black-blood MRI analysis was carried out within 1 week. Digital subtraction angiography (DSA) examination was carried out for 16 patients within 1 month.Results:
Totally, 103 plaques were detected in the 49 patients, which were characterized by localized or diffusive thickening of the vessel wall, with the intrusion of crescent-shaped abnormal signal into lumens. Fibrous cap was displayed as isointensity in T1-weighted image (T1WI) and hyperintensities in proton density weighted image (PDWI) and T2-weighted image (T2WI), lipid core was displayed as isointensity or slight hyperintensities in T1WI, isointensity, hyperintensities or hypointensity in PDWI, and hypointensity in T2WI. Calcification in plaques was detected in 11 patients. Eight patients were detected with irregular plaque surface or ulcerative plaques, which were characterized by irregular intravascular space surface in the black-blood sequences, black hypointensity band was not detected in three-dimensional time-of-flight, or the hypointensity band was not continuous, and intrusion of hyperintensities into plaques can be detected. Bright-blood and black-blood techniques were highly correlated with the diagnosis of contrast-enhanced MRA in angiostenosis degree, Rs = 0.97, P < 0.001. In comparison to DSA, the sensitivity, specificity, and accuracy of MRI diagnosis of stenosis for ≥50% were 88.9%, 100%, and 97.9%, respectively.Conclusions:
High-resolution bright-blood and black-blood sequential MRI analysis can accurately analyze ingredients in atherosclerotic plaques. Determined by DSA, MRI diagnosis of stenosis can correctly evaluate the serious degree of arteriostenosis. 相似文献14.
Lee JM Breslin NP Gopaul M Koh CW Kong TY Soong MM O'Morain CA 《Irish journal of medical science》2000,169(1):60-62
Background
While the eradication ofHelicobacter pylori in patients with bleeding peptic ulcer disease (PUD) decreases the rate of ulcer re-bleeding, the sensitivity of the rapid urease test (RUT) forH. pylori diagnosis is lower in this setting. The aim of this study was therefore to determine if exposing a gastric biopsy specimen to blood before its use in the RUT (CLOtest) could account for these findings. 相似文献15.
Awadhesh Kumar Mishra Ajith Nilakantan Kavita Sahai Rakesh Datta Ajay Malik 《Medical Journal Armed Forces India》2014
Background
Contact Endoscopy is a non invasive tool to visualise alterations in cell architecture in vivo. In this study we investigated the diagnostic accuracy of Contact Endoscopy in detecting malignancy in oral mucosal lesions.Methods
76 patients with oral mucosal lesions requiring biopsy were included. Contact Endoscopy was performed by Otolaryngologist before biopsy and findings recorded. The lesion was then biopsied and sent for histopathological examination by Pathologist who was blinded to Contact Endoscopy findings. Findings of Contact Endoscopy were compared with histopathological findings taking the latter as the gold standard. Two biopsies were reported as ‘inconclusive’ on histopathological examination and hence excluded from the final analysis. Data of the remaining 74 patients is presented here.Results
Clinically lesions were diagnosed as ulcero-proliferative lesions in 34 patients, Leukoplakia in 19, Erythroplakia in 9, Lichen planus in 5 and Submucous fibrosis in 7 patients. Histopathological examination revealed presence of malignancy in 97.06% of ulcero-proliferative mucosal lesions, 10.53% of leukoplakia and 33.33% of erythroplakia while corresponding figures on Contact Endoscopy were 94.12%, 5.26% and 11.11% respectively. No malignancy was detected in lichen planus and submucous fibrosis by either technique. When compared with histopathological examination, CE showed sensitivity of 84.21%, specificity of 94.44% and accuracy of 89.19%. No adverse effects on the patients were seen due to the procedure or stain.Conclusion
Contact Endoscopy may be useful in determining cellular structure in vivo without biopsy to detect oral malignancy early. Further studies are suggested. 相似文献16.
Background
Rheumatic heart disease (RHD) is still a common form of heart disease among children and young adults, especially in developing countries like India. Between 1940 and 1983, the prevalence rate of RHD varied from 1.8 to 11 per 1000 (national average 6 per 1000), while between 1984 and 1995 the rate varied from 1 to 5.4 per 1000 [1]. The study was carried out to assess the accuracy of a medical student''s clinical evaluation of valvular heart disease and compare it with that of an echocardiographic evaluation and to determine the sensitivity, specificity and predictive values of clinical examination as compared to echocardiography for the various lesions in RHD patients.Method
50 children between the ages of 5-16 years, attending the out patient department or admitted in a large teaching hospital, satisfying the criteria of RHD, were included in the study. Each patient underwent detailed clinical evaluation and relevant investigations including echocardiography.Results
Mitral valve was involved most often both by echocardiography and clinically. Isolated aortic valve involvement was rare. The most common lesion was mitral regurgitation (MR) both by auscultation and by echo. Mixed lesions were seen more often than pure lesions. Mitral stenosis (MS) had the highest sensitivity while tricuspid regurgitation (TR) had the highest specificity. MR had the highest positive predictive value and MS the highest negative predictive value. Sensitivity and specificity of aortic regurgitation (AR) was very low when compared to earlier studies. There was a statistically significant difference between echo diagnosis and clinical diagnosis (p < 0.05).Conclusion
It is recommended that echocardiography be done routinely for the diagnosis of cardiac lesions in patients of RHD as clinical examination alone can miss various lesions, especially when the lesions are mild or when multiple lesions are present.Key Words: Aortic valve, Children, Mitral valve, Rheumatic heart disease, Tricuspid valve 相似文献17.
Background
Endobronchial tuberculosis (EBTB) is a special form of pulmonary tuberculosis. In spite of much progress in the diagnosis of this disease in past years, delayed or mistaken diagnosis is still commonly seen.Objective
The aim of this study is to try to find out some useful clues for the diagnosis of EBTB, especially the early diagnosis.Methods
The medical records of patients with EBTB were analyzed retrospectively. Results: The male-to-female ratio was 1:2.2 out of 22 patients. Patients aged below 60-years-old constituted 72.7% of the cases. 22.7% of these patients were smokers. The male-to-female ratio of smokers was 4:1. 68.2% of these patients tested all showed negative result for the HIV test. The frequent complaints were cough, sputum, shortness of breath and fever, and antibiotic treatments were usually inefficacious. Multiple lobes lesion, exudative shadow and atelectasis were the frequent radiological findings. Acid-fast bacilli staining for sputum smear was positive in only 13.6% of these patients. Tuberculin skin test was positive in 59.1% of these patients. Granular lesion was the most common bronchoscopic appearance in these patients. Histological changes showed distinctive tuberculose lesion in 72.2% of 18 patients undergoing bronchoscopic biopsy.Conclusion
The diagnosis of EBTB is easily delayed or mistaken because of nonspecific clinical manifestations and the low incidence of positive acid-fast bacilli staining. A high index of awareness of this disease is required for diagnosis. Bronchoscopy should be performed as soon as possible in suspected patients, especially when patients present positive tuberculin skin test or no response to antibiotic treatments. 相似文献18.
Background
Significant gastrointestinal complications following cardiac surgery requiring cardiopulmonary bypass (CPB) are relatively infrequent but are associated with high morbidity and mortality rates. Acute acalculous cholecystitis (AAC) may be a devastating complication if the diagnosis is missed or management delayed. 相似文献19.
O'Leary C Feighery C Feighery A Quane K Shanahan F Molloy M Cronin CC 《Irish journal of medical science》2002,171(3):145-147
Background
Osteoporosis frequently complicates coeliac disease but most studies focus on symptomatic patients at the time of diagnosis. Screening tests have revealed that many individuals with coeliac disease have mild, atypical, or absent symptoms. 相似文献20.